Kathleen Carroll, COTA/L

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

2007016329 Issued in MO

Practice address

11960 Westline Industrial Dr
201
Saint Louis, MO 63146-3209

Phone

(314) 819-0480

NPI assigned

Mar 24, 2015

Last updated

Mar 24, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Supplemental Health Care

  • Physical Therapy Clinic/Center
  • Saint Louis, MO
  • NPI 1700172400
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427155200000",
    "number": "1245624675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 FOREST GROVE CT",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633046783",
            "telephone_number": "636-441-5303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11960 WESTLINE INDUSTRIAL DR",
            "address_2": "201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631463209",
            "telephone_number": "314-819-0480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "KATHLEEN",
        "name_prefix": "Mrs.",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-24",
        "last_updated": "2015-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": "2007016329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coleen O'Connor Carroll, PT
• Honor Bea Carroll
• James Andrew Carroll, M.D.
• Jazmon Monique Carroll
• Julianne Marie Carroll, M.S.
• Kimberly Jeanne Carroll, M.D.
• Laura Carroll, MS, CCC-SLP
• Micaela Carroll, RD, LD
• Nicole Pineda Carroll
• Samuel Carroll

• Student in an Organized Health Care Education/Training Program in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Student in an Organized Health Care Education/Training Program in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.